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Prevalence and incidence of anemia in the German Heinz Nixdorf Recall Study

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Abstract

This study aims to determine prevalence and incidence of anemia in the general population in Germany and evaluate a potential role of serum-free light chains (FLC) as biomarker in anemia. The population-based Heinz Nixdorf Recall Study comprises 4,814 men and women aged 45–75 years. Hemoglobin <13 g/dl in men and <12 g/dl in women defined anemia. Laboratory data was used to classify cases into renal, iron deficiency (IDA), vitamin B12/folic acid deficiency, anemia of chronic disease (ACD), and unexplained anemia (UA). Follow-up data was available from annual questionnaires, death certificates, and 5-year follow-up visit (5-year FU). Anemia cases (152) were identified (prevalence 3.2 %, 95 % CI 2.7–3.7). In participants aged 65 or older, prevalence was 4.3 % (95 % CI 2.9–6.0) in both men and women. Main anemia subtypes were: IDA 19 %, ACD 25 %, and UA 44 %. Incidence increased with age and was 12.8/1,000 person-years and 10.9/1,000 person-years in men and women aged 65 or older, respectively. UA was characterized by elevated FLC. Participants with elevated FLC and high-sensitivity C-reactive protein (hsCRP) had an increased risk of anemia at 5-year FU. FLC—alone or in combination with hsCRP—may serve as biomarker indicating an increased risk of developing anemia.

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References

  1. Merchant AA, Roy CN (2012) Not so benign haematology: anaemia of the elderly. Br J Haematol 156(2):173–185

    Article  PubMed  CAS  Google Scholar 

  2. Gaskell H, Derry S, Andrew Moore R, McQuay HJ (2008) Prevalence of anaemia in older persons: systematic review. BMC Geriatr 8:1. doi:10.1186/1471-2318-8-1

    Article  PubMed  Google Scholar 

  3. Ferrucci L, Maggio M, Bandinelli S, Basaria S, Lauretani F, Ble A, Valenti G, Ershler WB, Guralnik JM, Longo DL (2006) Low testosterone levels and the risk of anemia in older men and women. Arch Intern Med 166(13):1380–1388

    Article  PubMed  CAS  Google Scholar 

  4. Ershler WB, Sheng S, McKelvey J, Artz AS, Denduluri N, Tecson J, Taub DD, Brant LJ, Ferrucci L, Longo DL (2005) Serum erythropoietin and aging: a longitudinal analysis. J Am Geriatr Soc 53(8):1360–1365

    Article  PubMed  Google Scholar 

  5. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC (2004) Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 104(8):2263–2268

    Article  PubMed  CAS  Google Scholar 

  6. Bradwell AR, Carr-Smith HD, Mead GP, Tang LX, Showell PJ, Drayson MT, Drew R (2001) Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine. Clin Chem 47(4):673–680

    PubMed  CAS  Google Scholar 

  7. Hutchison CA, Basnayake K, Cockwell P (2009) Serum free light chain assessment in monoclonal gammopathy and kidney disease. Nat Rev Nephrol 5(11):621–628

    Article  PubMed  CAS  Google Scholar 

  8. Dispenzieri A, Kyle R, Merlini G, Miguel JS, Ludwig H, Hajek R, Palumbo A, Jagannath S, Blade J, Lonial S, Dimopoulos M, Comenzo R, Einsele H, Barlogie B, Anderson K, Gertz M, Harousseau JL, Attal M, Tosi P, Sonneveld P, Boccadoro M, Morgan G, Richardson P, Sezer O, Mateos MV, Cavo M, Joshua D, Turesson I, Chen W, Shimizu K, Powles R, Rajkumar SV, Durie BG (2009) International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 23(2):215–224

    Article  PubMed  CAS  Google Scholar 

  9. Hutchison CA, Landgren O (2011) Polyclonal immunoglobulin free light chains as a potential biomarker of immune stimulation and inflammation. Clin Chem 57(10):1387–1389

    Article  PubMed  CAS  Google Scholar 

  10. Schmermund A, Möhlenkamp S, Stang A, Grönemeyer D, Seibel R, Hirche H, Mann K, Siffert W, Lauterbach K, Siegrist J, Jöckel KH, Erbel R (2002) Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk Factors, Evaluation of Coronary Calcium and Lifestyle. Am Heart J 144(2):212–218

    Article  PubMed  Google Scholar 

  11. Eisele L, Dürig J, Hüttmann A, Dührsen U, Assert R, Bokhof B, Erbel R, Mann K, Jöckel KH, Moebus S (2012) Prevalence and progression of monoclonal gammopathy of undetermined significance and light-chain MGUS in Germany. Ann Hematol 91(2):243–248

    Article  PubMed  CAS  Google Scholar 

  12. Stang A, Moebus S, Dragano N, Beck EM, Möhlenkamp S, Schmermund A, Siegrist J, Erbel R, Jöckel KH (2005) Baseline recruitment and analyses of nonresponse of the Heinz Nixdorf Recall Study: identifiability of phone numbers as the major determinant of response. Eur J Epidemiol 20(6):489–496

    Article  PubMed  CAS  Google Scholar 

  13. Katzmann JA, Clark RJ, Abraham RS, Bryant S, Lymp JF, Bradwell AR, Kyle RA (2002) Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem 48(9):1437–1444

    PubMed  CAS  Google Scholar 

  14. Dürig J, Eisele L, Hüttmann A, Dührsen U, Führer A, Kieruzel S, Bokhof B, Erbel R, Mann K, Jöckel K-H, Moebus S (2010) Polyclonal free light chain elevation and mortality in the German Heinz Nixdorf Recall study. Hematol Rep 2:13

    Google Scholar 

  15. Endres HG, Wedding U, Pittrow D, Thiem U, Trampisch HJ, Diehm C (2009) Prevalence of anemia in elderly patients in primary care: impact on 5-year mortality risk and differences between men and women. Curr Med Res and Opin 25(5):1143–1158

    Article  Google Scholar 

  16. Tettamanti M, Lucca U, Gandini F, Recchia A, Mosconi P, Apolone G, Nobili A, Tallone MV, Detoma P, Giacomin A, Clerico M, Tempia P, Savoia L, Fasolo G, Ponchio L, Della Porta MG, Riva E (2010) Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study. Haematologica 95(11):1849–1856

    Article  PubMed  Google Scholar 

  17. Coad J, Conlon C (2011) Iron deficiency in women: assessment, causes and consequences. Curr Opin Clin Nutr Metab Care 14(6):625–634

    Article  PubMed  CAS  Google Scholar 

  18. Ferrucci L, Guralnik JM, Woodman RC, Bandinelli S, Lauretani F, Corsi AM, Chaves PH, Ershler WB, Longo DL (2005) Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med 118(11):1288

    Article  PubMed  Google Scholar 

  19. Grundy SM (2001) Coronary calcium as a risk factor: role in global risk assessment. J Am Coll Cardiol 37(6):1512–1515

    Article  PubMed  CAS  Google Scholar 

  20. Hamirani YS, Pandey S, Rivera JJ, Ndumele C, Budoff MJ, Blumenthal RS, Nasir K (2008) Markers of inflammation and coronary artery calcification: a systematic review. Atherosclerosis 201(1):1–7

    Article  PubMed  CAS  Google Scholar 

  21. Hutchison CA, Harding S, Hewins P, Mead GP, Townsend J, Bradwell AR, Cockwell P (2008) Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease. Clin J Am Soc Nephrology: CJASN 3(6):1684–1690

    Article  CAS  Google Scholar 

  22. Pardanani A, Lasho TL, Finke CM, Rajkumar SV, Singh PP, Ketterling RP, Hanson CA, Katzmann JA, Tefferi A (2012) Polyclonal immunoglobulin free light chain levels predict survival in myeloid neoplasms. J Clin Oncol 30(10):1087–1094

    Article  PubMed  Google Scholar 

  23. Weiss G, Goodnough LT (2005) Anemia of chronic disease. N Engl J Med 352(10):1011–1023

    Article  PubMed  CAS  Google Scholar 

  24. Ferrucci L, Semba RD, Guralnik JM, Ershler WB, Bandinelli S, Patel KV, Sun K, Woodman RC, Andrews NC, Cotter RJ, Ganz T, Nemeth E, Longo DL (2010) Proinflammatory state, hepcidin, and anemia in older persons. Blood 115(18):3810–3816

    Article  PubMed  CAS  Google Scholar 

  25. Waalen J, von Lohneysen K, Lee P, Xu X, Friedman JS (2011) Erythropoietin, GDF15, IL6, hepcidin and testosterone levels in a large cohort of elderly individuals with anaemia of known and unknown cause. Eur J Haematol 87(2):107–116

    Article  PubMed  CAS  Google Scholar 

  26. Artz AS, Thirman MJ (2011) Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic. J Gerontol A Biol Sci Med Sci 66(8):925–932

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank the Heinz Nixdorf Foundation (Chairman: † Dr. jur. G. Schmidt, Essen, Germany) for the sponsoring of the Heinz Nixdorf Recall Study. We also thank the Investigative Group and the study personnel of the Heinz Nixdorf Study. We gratefully acknowledge the collaboration with D. Grönemeyer, R. Seibel, L. Volbracht.

Heinz Nixdorf Recall Study advisory board: T. Meinertz, Germany (Chair); M. Blettner, Germany; C. Bode, Germany; PJ. de Feyter, Netherlands; B. Güntert, Austria; F. Gutzwiller, Switzerland; H. Heinen, Germany; O. Hess, Switzerland; B. Klein, Germany; H. Löwel, Germany; M. Reiser, Germany; G. Schmidt, Germany; M. Schwaiger, Germany; C. Steinmüller, Germany; T. Theorell, Sweden; S.N. Willich, Germany.

Funding

This study was supported by an internal research grant to L.E. from the Faculty of Medicine of the University Hospital of Essen (IFORES). Parts of the study were funded by a research grant from Celgene, Munich, Germany. FreeLite Kits were in part provided for free by The Binding Site, Birmingham, UK. Measurement of laboratory parameters in anemia cases was in part supported by Siemens, Germany. The Heinz Nixdorf Recall Study was supported by the Heinz Nixdorf Foundation and a research grant from the German Ministry of Education and Science (BMBF).

Authorship

LE designed the study, did the analysis, and wrote the paper; JD and UD designed the study; MBP contributed laboratory equipment and provided support in writing the manuscript; BB collected study data, validated study endpoints and provided data processing; KHJ designed the Heinz Nixdorf Recall study, contributed to the analysis; SM and RE designed the Heinz Nixdorf Recall study; all authors critically reviewed the manuscript.

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The authors declare that they have no conflict of interest.

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Correspondence to Lewin Eisele.

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Eisele, L., Dürig, J., Broecker-Preuss, M. et al. Prevalence and incidence of anemia in the German Heinz Nixdorf Recall Study. Ann Hematol 92, 731–737 (2013). https://doi.org/10.1007/s00277-013-1697-1

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  • DOI: https://doi.org/10.1007/s00277-013-1697-1

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